Mechanical ventilation alters the immune response in children without lung pathology

被引：0

作者：

Frans B. Plötz

Harriet A. Vreugdenhil

Arthur S. Slutsky

Jitske Zijlstra

Cobi J. Heijnen

Hans van Vught

机构：

[1] Pediatric Intensive Care Unit,

[2] University Medical Center Utrecht,undefined

[3] P.O. Box 85090,undefined

[4] 3508 AB Utrecht,undefined

[5] Present address: St. Antonius Hospital,undefined

[6] Department of Pediatrics,undefined

[7] P.O. Box 2500,undefined

[8] 3435 CM Nieuwegein,undefined

[9] Department of Pediatric Immunology,undefined

[10] Section Psycho-neuro-immunology,undefined

[11] University Medical Center Utrecht,undefined

[12] P.O. Box 85090,undefined

[13] 3508 AB Utrecht,undefined

[14] Division of Respiratory Medicine,undefined

[15] St. Michael's Hospital,undefined

[16] University of Toronto,undefined

[17] Toronto,undefined

[18] Ontario,undefined

来源：

Intensive Care Medicine | 2002年 / 28卷

关键词：

Mechanical ventilation Cardiac catheterization Interleukins Tumor necrosis factor α Interferon γ Natural killer cells Volatile anesthetics;

D O I：

暂无

中图分类号：

学科分类号：

摘要：

Objective: This study was undertaken to examine the hypothesis that mechanical ventilation in association with anesthesia would alter the cytokine profile in infants without preexisting lung pathology. Design and setting: Prospective observational study in pediatric intensive care unit in a university hospital. Patients: Twelve infants who were subjected to an uncomplicated diagnostic cardiac catheterization procedure were studied. All subjects were ventilated with a volume control mode, 0.3 FIO2, 4 cmH2O PEEP, and 10 ml/kg tidal volume. Volatile (servoflurane) anesthetics were given. Measurements and results: Tracheal aspirates and blood samples were obtained before and after 2 h of mechanical ventilation. In tracheal aspirates and in supernatants of stimulated whole-blood cultures cytokine concentrations were measured. In the tracheal aspirates the immune balance was characterized by a proinflammatory response pattern, with a significant increase in TNF-α and IL-6 concentrations; concentrations of anti-inflammatory mediators remained very low. The functional capacity of peripheral blood leukocytes to produce INF-γ, TNF-α, and IL-6 in vitro was significantly decreased. This was accompanied by a significant decrease in the killing activity of natural killer cells. Conclusions: Two hours of servoflurane and mechanical ventilation using a tidal volume of 10 ml/kg is associated with remarkable changes in the immune response in infants without preexisting lung pathology undergoing cardiac catheterization. In the lungs the immune balance favors a proinflammatory response pattern without detectable concentrations of anti-inflammatory mediators. The Th1 immune response by peripheral blood leukocytes was decreased. The observed change in Th1/Th2 balance in favor of Th2 cytokine activity may be a systemic adaptation to the proinflammatory milieu in the lung.

引用

页码：486 / 492

页数：6